Neuropsychiatric Disease and Treatment
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Attitudes and beliefs of patients with chronic
depression toward antidepressants and depression
Sabrina Anne Jacob 1
Ab Fatah Ab Rahman 2
Mohamed Azmi Ahmad
Hassali 3
1
School of Pharmacy, Monash
University Malaysia, Sunway, 2Faculty
of Health Sciences, Gong Badak
Campus, Universiti Sultan Zainal
Abidin (UniSZA), Kuala Terengganu,
3
School of Pharmaceutical Sciences,
University of Science Malaysia,
Minden, Malaysia
Correspondence: Sabrina Anne Jacob
School of Pharmacy, Monash University
Malaysia, Jalan Lagoon Selatan, 47500
Bandar Sunway, Selangor, Malaysia
Tel +60 35 514 5885
Email sabyj@hotmail.com
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http://dx.doi.org/10.2147/NDT.S82563
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Original Research
This article was published in the following Dove Press journal:
Neuropsychiatric Disease and Treatment
27 May 2015
Number of times this article has been viewed
Background: Many patients have erroneous views with regard to depression and its management,
and it was noted that these attitudes and beliefs significantly affected their adherence rates.
Objectives: The primary aim of this study was to determine the attitudes and beliefs of patients
with depression toward depression and antidepressants. A secondary aim was to assess the
influence of ethnicity on patients’ attitudes and beliefs.
Patients and methods: The study involved patients with chronic depression being followed
up at an outpatient clinic at a government-run hospital in Malaysia. Patients’ attitudes and beliefs
were assessed using the Antidepressant Compliance Questionnaire.
Results: A total of 104 patients of Malay, Chinese, and Indian ethnic groups met the selection
criteria. Chinese patients had significantly negative attitudes and beliefs toward depression and
antidepressants compared to Malays and Indians (b=-8.96, t103=-3.22; P0.05). Component
analysis revealed that 59% of patients believed that antidepressants can cause a person to have
less control over their thoughts and feelings, while 67% believed that antidepressants could
alter one’s personality; 60% believed it was okay to take fewer tablets on days when they felt
better, while 66% believed that antidepressants helped solve their emotional problems and
helped them worry less.
Conclusion: Patients had an overall positive view as to the benefits of antidepressants,
but the majority had incorrect views as to the acceptable dosing of antidepressants and had
concerns about the safety of the medication. Assessing patients’ attitudes and beliefs, as well
as the impact of their respective cultures, can be used in tailoring psychoeducation sessions
accordingly.
Keywords: Chinese, Malaysia, ethnicity, culture
Introduction
A large number of patients with depression have incorrect and negative views not only
toward antidepressants but depression itself.1–6 The most common misperception among
these patients is that depression is caused only by nonbiological or environmental fac-
tors, such as stress or family problems.7–9 Patients also believe that antidepressants are
addictive,2,10,11 that they can alter the patient’s personality,12,13 that fewer tablets can
be taken on days when one feels better, and that extra tablets can be taken on days
when they feel depressed.12
A significantly negative correlation has been found between patients’ attitudes and
beliefs toward depression and antidepressants and the percentage of days medication
was missed. Therefore, subjects with negative attitudes missed their medications
more frequently.11,12,14 In fact, research has shown that compared to side effects and
demographics, patients’ beliefs about a disease and its perceived controllability or
consequences had a greater influence on patients’ adherence rates.15,16 Indeed, it is also
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Jacob et al
one of the few alterable characteristics that can be targeted by
clinicians in programs to increase adherence rates.12,15,17–19
Cultural differences in beliefs about diseases have
resulted in different perceptions and ways in which people
from different cultures seek treatment.8,20–22 Givens et al
conducted a cross-sectional Internet survey where responses
were rated using a 5-point Likert scale. The study involved
68,319 Caucasians, 3,596 African–Americans, 2,794
Asians/Pacific Islanders, and 3,203 Hispanics. Results
revealed that African–Americans, Asians/Pacific Island-
ers, and Hispanics were less likely than Caucasians to
attribute depression to biological factors or to believe that
medicines were effective in treating depression, believing
instead in nonpharmacological options, such as counseling
and prayer. Other than that, a higher percentage believed
antidepressants were addictive compared to Caucasians.23
In a cross-sectional study utilizing the Beliefs about Medi-
cation Questionnaire – general scale and Sensitive Soma
Scale involving 83 Asians and 417 Europeans, Horne et al
found that Asians had more negative views about medica-
tion compared to the Western population, and believed
that prolonged use could lead to harm and addiction.21 A
telephone survey by Cooper et al involving 659 Cauca-
sians, 97 African–Americans, and 73 Hispanics found that
Hispanics may be more concerned about the side effects of
antidepressants than Caucasians.24
It is therefore important to determine the cultural aspects
that influence the beliefs and attitudes of the patients, so that
these erroneous beliefs can be addressed in an appropriate
manner.3,12,15 Most studies however usually involve the West-
ern population, which makes generalizability to the Asian
population inaccurate; particularly those in the Southeast
Asian region. There seems to be a false assumption that indi-
viduals on one end of the world would share similar health
beliefs with individuals on the other end of the world simply
because of a shared sex.25 As such, this study sought to elicit
the attitudes and beliefs of patients toward antidepressants
and depression, and to assess the influence of ethnicity on
patients’ attitudes and beliefs.
Patients and methods
This study was part of the Pharmacy-Managed Adherence
Program study, a 6-month randomized prospective study
designed to investigate the effect of the program on adher-
ence levels. The study involved patients with chronic
depression being followed up at the outpatient clinic of
the psychiatric department of a government-run hospital in
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Malaysia.26 Results reported here represent baseline data
from the study.
All patients who were diagnosed with major depressive
disorder according to the fourth edition of the Diagnostic
and Statistical Manual of Mental Disorders, regardless of
severity, and who had been on antidepressants for a mini-
mum of 6 months were included in the study. Sample size
was calculated for a type I error of 0.05 and a power of 0.80.
In order to detect an absolute difference of 25% in the propor-
tion of patients judged to have adequate adherence and taking
into account a predicted dropout rate of 30%, the sample
size needed was 160 patients. The following patients were
excluded: patients with a comorbid psychiatric diagnosis,
such as schizophrenia or bipolar disorder during the study
period, patients 18 years of age, patients who were pregnant
or breast-feeding, patients with current suicidal ideation or
with a terminal illness, patients with dementia, cognitive
disabilities, mental retardation, Alzheimer’s, or Parkinson’s,
patients who did not understand/speak/read English or the
national language (Bahasa Malaysia [BM]), and patients
who had no telephone.
Patients who agreed to participate and who signed
informed consent forms were asked to fill in the Antidepres-
sant Compliance Questionnaire (ADCQ), which was used to
measure patients’ attitudes and beliefs toward depression and
antidepressants. Symptom severity was assessed using the
Montgomery–Åsberg Depression Rating Scale (MADRS),27
which was administered by a trained psychiatrist. Demo-
graphic data as well as medical and psychiatric history were
also obtained from each patient. Patients’ files were also
checked to see if they attended counseling sessions.
Study instruments
Montgomery–Åsberg Depression Rating Scale
The MADRS is a clinician-rated scale that consists of ten
items, namely apparent sadness, reported sadness, inner
tension, reduced sleep, reduced appetite, concentration dif-
ficulties, lassitude, inability to feel, pessimistic thoughts, and
suicidal thoughts. For each item, the rating can range from
0 to 6, where 0 equals no symptoms and 6 equals severe
symptoms. The total score is then tabulated, and the follow-
ing scoring system used to determine the patient’s severity:
0–6 indicates recovery, 7–19 indicates mild depression,
20–34 indicates moderate depression, and 35 and above
signifies severe depression.28 The time period covered by
the scale is the clinical condition of the patient at the time
of the interview.29 The scale is available in both the English
Neuropsychiatric Disease and Treatment 2015:11
Dovepress Patient attitudes toward antidepressants and depression

and BM versions. The BM version was obtained from the Results

MAPI Research Institute.30 Characteristics of study participants
A total of 104 patients met the selection criteria and were
Antidepressant Compliance Questionnaire administered the study instruments (Table 1). All patients,
The ADCQ is a 33-item questionnaire that is divided into four who were on once-daily dosing, were on only one antidepres-
components, namely: perceived doctor–patient relationship sant, except for two patients who were on two antidepres-
(component 1), preserved autonomy (component 2), positive sants. Of the 49 unemployed patients, 75.5% were women.
beliefs on antidepressants (component 3), and partner agreement Of these, 33 (67.3%) were housewives.
(component 4). Scoring is as follows: components 1 and 4:
1 – mostly disagree, 2 – rather disagree, 3 – rather agree, and
4 – mostly agree; component 2: 1 – mostly agree, 2 – rather Table 1 Demographics of study participants (n=104)
agree, 3 – rather disagree, and 4 – mostly disagree. In com- Characteristics Number (%) of patients
ponent 3, the items 8, 23, 26, and 31 are scored as follows: Sex
1 – mostly agree, 2 – rather agree, 3 – rather disagree, and Male 38 (36.5)
Female 66 (63.5)
4 – mostly disagree, while the other items are scored as follows: Race
1 – mostly disagree, 2 – rather disagree, 3 – rather agree, and Malay 44 (42.3)
4 – mostly agree. Total score is 132. The higher the score, the Chinese 26 (25.0)
Indian 34 (32.7)
more positive the patient’s beliefs and attitudes toward antide-
Age, years (mean ± SD) 45.7±11.9
pressants and depression.31 The scale was translated to BM using
Duration of disease, months (mean ± SD) 69.0±53.5
Brislin’s back-translation method, as proposed by the World
Marital status
Health Organization.32,33 Both the English and the BM scales Single 21 (20.2)
were made available to the patients. Face and content validation Married 74 (71.2)
of the BM version was conducted by the principal investigator Divorced 5 (4.8)
Widowed 4 (3.8)
and four psychiatric specialists from the hospital, while a test–
Education
retest longitudinal design was used to analyze reliability. Primary (year 1–6) 16 (15.4)
Secondary (year 7–13) 64 (61.5)
Statistical analysis Tertiary (diploma/university) 24 (23.1)
Baseline demographic data are presented using descriptive Number of patients with employment 55 (52.9)
MADRS symptom severity
statistics. Continuous variables are expressed by means and
Recovery 38 (36.5)
standard deviations, whereas categorical/nominal data are pre- Mild 35 (33.7)
sented using frequency and percentage. For translation of the Moderate 24 (23.1)
ADCQ, internal consistency was analyzed using Cronbach’s α. Severe 7 (6.7)
Comorbid psychiatric disorders
A measure of 0.70 and above was considered highly related.34
Anxiety 28 (26.9)
Test–retest reliability was explored at two time points, Obsessive–compulsive 2 (1.92)
2 weeks apart. Data were analyzed using Pearson’s correlation. Panic 1 (0.96)
Results were considered to be significant at the 5% critical level Phobia 1 (0.96)
PTSD 1 (0.96)
(P0.05). MADRS and ADCQ were scored using the scor-
Prescribed antidepressant
ing algorithm described by the scale designers. Simple linear Fluvoxamine 36 (34.6)
regression analyses were performed to determine independent Sertraline 24 (23.1)
influential factors for total ADCQ scores. The a priori level of Escitalopram 18 (17.3)
Fluoxetine 4 (3.8)
significance was 0.05, and all analyses were performed using
Venlafaxine 9 (8.7)
SPSS 18.0 statistical software (SPSS Inc, Chicago, IL, USA). Mirtazapine 8 (7.7)
Duloxetine 4 (3.8)
Ethical approval Dothiepin 2 (1.9)
Amitriptyline 1 (0)
Ethical approval was sought and received from the Medical
Attending psychological counseling 17 (16.3)
Research Ethics Committee (MREC) of Malaysia ([6]dlm. Abbreviations: SD, standard deviation; MADRS, Montgomery–Åsberg Depression
KKM/NIHSEC/O8/0804/P10-79). Rating Scale; PTSD, posttraumatic stress disorder.

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Table 2 Internal consistency of ADCQ components Patients’ attitudes and beliefs

Component Questions Cronbach’s α* The mean total ADCQ score was 96.95 (±12.85). Simple
I 2, 5, 7, 12, 14, 15, 16, 19, 0.892 linear regression analyses revealed that total ADCQ scores
20, 21, 22, 25, 27, 28, 29 were significantly predicted by Chinese ethnicity (Table 3).
II 1, 3, 6, 9, 13, 24, 30 0.613
The four components of the ADCQ were analyzed separately
III 4, 8, 17, 23, 26, 31, 32, 33 0.641
IV 10, 11, 18 0.909 (Table 4). Scores for the first two columns (“mostly disagree”
Notes: *Cronbach’s value .0.70 considered highly reliable. and “rather disagree”) were summed up to give a composite
Abbreviation: ADCQ, Antidepressant Compliance Questionnaire. picture of what patients disagreed on, while the scores for the
last two columns (“rather agree” and “mostly agree”) were
Reliability analysis of ADCQ totaled to give a composite picture of what patients agreed
For the BM version of the ADCQ, Cronbach’s α was 0.90. on, as was done in a previous study.31
Table 2 shows results when analyzed by components. Test– On component 1 (perceived doctor–patient relationship),
retest analysis found a significant correlation for the BM more than 80% felt that their doctor listened properly to what
version of the ADCQ (r=0.75, P=0.013). they thought about antidepressants and stressed the importance

Table 3 Simple linear regression analysis for factors associated with ADCQ score in 104 patients with chronic depression
Model SLR
b‡ 95% CI P-value
Age (years) -0.19 -0.40 to 0.02 0.07
Length of time in psychiatric care (months) -0.02 -0.07 to 0.03 0.38
Sex
Female 1.0
Male -0.88 -6.09 to 4.34 0.74
MADRS score -2.27 -4.91 to 0.39 0.09
Education
Primary 1.0
Secondary 1.18 -3.99 to 6.34 0.65
Tertiary -0.23 -5.74 to 6.19 0.94
Race
Malay 1.0
Chinese§ -8.96 -14.49 to -3.43 0.01*
Indian 2.13 -3.22 to 7.47 0.43
Race
Chinese 1.0
Indian 2.13 -3.22 to 7.47 0.43
Malay 4.97 -0.02 to 9.96 0.051
Race
Indian 1.0
Chinese -8.96 -14.49 to -3.43 0.01*
Malay 4.97 -0.02 to 9.96 0.051
Relationship status
Single 1.0
Married -0.77 -6.31 to 4.47 0.78
Divorced 2.36 -9.37 to 14.10 0.69
Widowed -2.03 -15.09 to 11.03 0.76
Employment status
Yes 1.0
No -1.84 -6.86 to 3.18 0.47
Attended counseling session
No 1.0
Yes 0.34 -6.46 to 7.13 0.92
Notes: ‡Crude regression coefficient; *P0.05; §r2 (coefficient of determination) =0.09.
Abbreviations: ADCQ, Antidepressant Compliance Questionnaire; SLR, simple linear regression; CI, confidence interval; MADRS, Montgomery–Åsberg Depression
Rating Scale.

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Dovepress Patient attitudes toward antidepressants and depression

Table 4 Component analysis of ADCQ of 104 patients with chronic depression

Component (n=104) Mostly Rather Rather Mostly
disagree (%) disagree (%) agree (%) agree (%)
Component 1
My doctor listens properly to what I think about antidepressants 5 13 36 47
My doctor has made me feel confident that antidepressants 6 15 34 45
are the suitable treatment for my depression
My doctor takes sufficient time to listen to my problems 7 8 31 55
My doctor has explained the causes of my depression sufficiently 13 17 29 40
My doctor takes sufficient time to discuss my emotional 7 15 30 48
problems
My doctor has explained depression sufficiently to me 14 15 26 44
My doctor shows sufficient consideration for my views 11 9 42 38
and feelings about his treatment with antidepressants
I receive sufficient psychological support and encouragement 7 17 30 46
from my doctor
My doctor fully understands my condition 7 15 29 49
My doctor strongly emphasizes that it is important to take 5 12 25 59
the antidepressants regularly
My doctor is really interested in my problems 6 17 32 45
My doctor listens properly when I tell him what it is like 4 12 42 42
to be depressed
My doctor understands my feelings and thoughts on 10 15 37 38
depression perfectly
My doctor has explained properly about antidepressants, 17 17 28 38
their action, and side effects
My doctor listens properly to what I consider to be the 9 11 39 41
causes of my depression
Component 2
As long as you are taking antidepressants, you do not really 21 19 31 29
know if they are actually necessary
When you have taken antidepressants over a long period 16 25 29 30
of time, it is difficult to stop taking them
When you take antidepressants, you have less control over 20 21 29 30
your thoughts and feelings
Antidepressants can alter your personality 14 18 38 29
Your body can become addicted to antidepressants 35 23 21 21
Your body can become immune to antidepressants 28 17 35 20
Skipping a day now and again prevents your body from 35 32 24 10
becoming immune to the antidepressants
Component 3
With antidepressants, the causes of my depression disappear 4 14 34 48
You may take fewer tablets than prescribed on days when 25 15 26 34
you feel better
Antidepressants help me to worry less about my problems 2 13 39 45
If you forget to take the antidepressants on a certain day, 64 24 6 6
it is better to take an additional dose the following day
You may take more tablets than prescribed on days when 51 17 18 13
you feel more depressed
I think my depression is only due to factors associated with 24 24 27 25
my personality
My emotional problems are solved by the antidepressants 11 18 32 39
Antidepressants make me stronger, so I will be able to deal 6 24 32 38
more efficiently with my problems
Component 4
My partner agrees that antidepressants are a suitable 33 13 23 32
treatment for my condition
Antidepressants correct the changes that occurred in my 3 9 40 48
brain due to stress or problems
My partner agrees that depression is the correct diagnosis 29 16 24 31
of my condition
Abbreviation: ADCQ, Antidepressant Compliance Questionnaire.

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Jacob et al
of taking their antidepressants regularly, while 77% agreed
that their doctor provided sufficient psychological support and
encouragement. On component 2 (preserved autonomy), more
than 40% of patients believed that antidepressants were addic-
tive, that the body could become immune to antidepressants,
and that skipping a day now and again could prevent the body
from becoming immune to them; 59% believed it would be
difficult to stop taking antidepressants when they have been
taken over a long period of time, and a further 67% believed
that antidepressants could alter one’s personality.
On component 3 (positive beliefs on antidepressants),
more than 30% of patients believed it was appropriate to take
more tablets than prescribed on days when they felt more
depressed, while 60% believed it was okay to take fewer tab-
lets on days when they felt better. Sixty six percent believed
that antidepressants helped solve their emotional problems,
and helped them worry less. Meanwhile, 52% felt that depres-
sion was only due to factors associated with their personality.
On component 4 (partner agreement), approximately 90%
believed that antidepressants could correct the changes that
occurred in their brain due to stress or problems.
Discussion
The mean total ADCQ score was 96.95, which was slightly less
than that reported by Chakraborty et al who found a total mean
score of 105.06.12 As there is no official scale for comparison
proposed by the scale designers, we can surmise that the
overall attitudes and beliefs of our patients toward depression
and antidepressants were quite positive, given that the total
score for all 33 items of the ADCQ would amount to 132. The
majority of our respondents were female and young adults, and
approximately 70% of those unemployed were housewives.
These three characteristics could somewhat explain the more
positive attitude based on results from previous studies.3,12,21
Simple linear regression analyses found that Chinese
patients had significantly more negative attitudes and beliefs
toward depression and antidepressants compared to Malay
and Indian patients. In the Chinese culture, similar to that seen
in South Koreans, mental illnesses are viewed as shameful not
only to the individual but to the family as well. Jang et al noted
that Asians of Chinese descent tend to follow Confucian ethics,
which state that “self-concealment of emotional trouble is a
virtue”.3 Therefore, patients tend to tolerate the disease internally
and suppress their emotions, instead of seeking treatment.
In our study, it was also observed that Malay patients
had more positive attitudes and beliefs toward depression
and antidepressants. Malaysia is a multiracial country made
up of 60% Malays, more than 20% Chinese, and less than
10% Indians. By constitutional law, all Malays are Muslims.
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In a study assessing suicide ideation in Malaysian patients,
the more religious patients had significantly lower suicide
ideation scores, and this was most pronounced in Muslims.35
Therefore, we can postulate that greater religiosity in Malay
patients compels them to seek treatment, as suicide is pro-
hibited in Islam.36 Studies have also shown that Chinese and
Indian patients prefer traditional therapy, such as ayurveda,
or “sin sehs”, compared to Western medication; which could
explain their more negative attitudes and beliefs toward
antidepressants as compared to Malay patients.3,7,37
In keeping with results found by Demyttenaere et al,31
Chakraborty et al12 and other studies,38,39 no significant relation-
ship was found between symptom severity and ADCQ scores.
There was no significant correlation between ADCQ scores
and sex, age, and attending counseling sessions either.
Component analysis
On component 1, the majority of patients gave positive
feedback as to the care received from their doctors. It must
however be taken into account that Asians tend to have very
high respect for doctors and view them almost as gods.12
In answering this section, a few patients expressed concern,
as they were worried whether the doctors could view their
answers and were concerned about the repercussions; there-
fore, results could have been compromised.
With regard to component 2, roughly 60% of respondents
believed that as long as they were taking antidepressants, they
were not sure if they were actually necessary, and that the
medication made them have less control over their thoughts
and feelings. In previous studies, patients expressed nega-
tive views about antidepressants and felt they reduced their
alertness.8,13,31 A large number of patients in our study also
believed that antidepressants could alter one’s personality, and
that one could become immune to the drugs. Indeed, studies
have revealed that patients were worried that taking antide-
pressants on a daily basis could be harmful to the body.6,40
Approximately 60% of patients felt that it was difficult to
stop taking antidepressants once one had started taking them,
and this is true especially with regard to certain antidepressants,
such as mirtazapine and venlafaxine, which cannot be stopped
abruptly, and instead have to be tapered off over several days
to weeks. Many patients in our study also believed that anti-
depressants could cause addiction, echoing several studies or
reviews where patients either expressed a concern over the
potential for addiction with antidepressants or simply stopped
their medication completely due to fear of addiction.2,8,13,18,20,41
This is because most people tend to confuse antidepressants
with tranquilizers, which have the potential for addiction, since
most antidepressants also cause drowsiness.42
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In component 3, the majority of our patients had
positive beliefs regarding antidepressants, with more
than 80% believing they helped them worry less about
their problems and 70% believing they solved their prob-
lems. This is contrary to studies conducted in Western
populations, as well as studies involving Asians living
in Western countries, where the majority of patients had
negative views toward antidepressants. 18,21,23,31 Western
cultures are more individualistic, and place importance
on asserting individual independence and autonomy.
Eastern cultures, on the other hand, stress that responsi-
bility to the community is greater than duty to oneself.
This could somewhat explain why Easterners have
more favorable views, as they feel antidepressants will
help them maintain the status quo in the community. 25
In a paper by Horne et al, Asians reported less experi-
ence with prescribed medication compared to the Western
population.21 This is not surprising, given that many Asians
tend to resort first to traditional medicine.3,7,37 However,
having more experience with medication could also mean
that the Western population are more aware of the side
effects associated with these medications, and this perhaps
has elicited more negative views toward antidepressants.
Our results also show that we cannot assume similarity with
Asians living in Western countries, as there is the issue of
cross-culture influence from their adoptive country. There-
fore results obtained from those studies cannot necessarily
be applied to our population.21,23
A substantial number of patients in this study however
seem to have erroneous views with regard to the dosing of
antidepressants. More than 30% believed extra doses could
be taken on days when they felt low, and 60% believed it
was acceptable to take fewer doses on days when they felt
better. Patients tend to go on “drug holidays” or alter their
doses when they feel better, and a study found a significant
correlation between patients who stopped their medication
when they felt better with perceived stigma toward depres-
sion. This could explain our findings with regard to the cul-
tural stigma, whereby patients want to stop the medication
as soon as possible.43
Finally, more than 50% of respondents believed that depres-
sion was caused by their own personality. This is similar to other
studies, where the majority believed that depression was mainly
a psychological problem and not a medical problem.4,13,20,44 This
points to the nature of patients who prefer to support only a
nonbiological cause of depression, which then causes them to
reject biological interventions, ie, antidepressants in moderate-
to-severe cases, as they feel they can heal themselves by simply
changing their behavior or personality.8
Neuropsychiatric Disease and Treatment 2015:11
Patient attitudes toward antidepressants and depression
Limitations
We were unable to reach the target sample size due to the
strict inclusion and exclusion criteria with regard to language
requirements. As mentioned earlier, patients were rather
hesitant to answer the questionnaires for fear that the doctors
would see their responses. This too could have affected the
final results obtained. Given that this study only involved
one center where the majority of patients came from low to
middle socioeconomic backgrounds, this might somewhat
limit the generalizability of the results.
Conclusion
The majority of patients gave very positive feedback with
regard to the care received from the physicians, and a sub-
stantial amount also believed in the effectiveness of antide-
pressants. However, most patients had erroneous views with
regard to the perceived harmful effects of antidepressants.
Patients’ beliefs and attitudes influence their adherence,
outcome, and preference for treatment. By understanding
patients’ beliefs about their treatment, as well as the impact
of their respective cultures, clinicians can alter treatment
accordingly, either through the dissemination of informa-
tion or through improved patient–prescriber relationships.
More detailed research should also be done to assess the
influence of ethnicity on patients’ attitudes and beliefs, so
as to ensure the generalizability of research outcomes.
Acknowledgments
We wish to thank the staff of the Psychiatric Department
of Hospital Tengku Ampuan Rahimah, Klang for their
help in conducting the research. This study was supported
by a grant from the Research and Creativity Management
Office (RCMO) of Universiti Sains Malaysia (304/
PFARMASI/6311025).
Author contributions
All authors contributed toward data analysis and drafting
and revising the paper, and agree to be accountable for all
aspects of the work.
Disclosure
The authors report no conflicts of interest in this work.
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